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Case Study: Human Trafficking Prevention at Dignity Health

This member-only article appears in the December issue of Patient Safety Monitor Journal.

With a span of providers reaching almost half the country, the Dignity Health system kicked off its Human Trafficking Response (HTR) Program in 2014 with the intent of identifying and helping trafficking victims. Within a year, it identified at least 31 people with high or moderate indicators that they were victims of human trafficking, and that number has grown with each year since.

Between 2007 and 2017, the National Human Trafficking Hotline has identified 43,564 human trafficking victims living in the U.S. At least 88% of these victims visit a healthcare provider at least once during their captivity and aren’t recognized as victims, say experts.

Healthcare regulators like The Joint Commission and the National Association of Pediatric Nurse Practitioners have put out resources and alerts on this problem. Just this June, the Centers for Disease Control and Prevention’s National Center for Health Statistics released new ICD-10 codes for classifying human trafficking abuse. (For further reference, PSMJ wrote an update on human trafficking patients in September, and a longer article on diagnosing human trafficking when a patient is a victim in 2017.)

There’s also strong evidence to suggest the real number of victims is much higher, and growing, than what’s been reported. As awareness (and pressure from regulators) grows, hospitals, physicians, nurses, and caregivers can take an active role in helping victims.

Headquartered in San Francisco, the Dignity Health system is a multi-state network of 400 care sites and 60,000 employees. Holly Austin Gibbs is the director of Dignity Health’s HTR Program, author of the book Walking Prey: How America’s Youth Are Vulnerable to Sex Slavery, and a child sex trafficking survivor. She’s also consulted for the Office for Victims of Crime, the National Center for Missing & Exploited Children, and the AMBER Alert program.

“Trafficked persons are often overlooked, even though most survivors report that they have visited a healthcare setting at least once while being trafficked,” says Gibbs. “Dignity Health has developed a victim-centered, trauma-informed program based on actual cases because we believe that healthcare providers can provide a critical step in identifying and supporting trafficked persons.”

Creating new programs
Dignity Health is working with providers, hospitals, and healthcare organizations across the country to create their own HTR programs. Much of the organization’s resources and guidelines are free online, such as the Human Trafficking 101: Dispelling the Myths module, the PEARR Tool, and the Shared Learnings Manual.

The training module deals with common stereotypes of trafficking. For example, while some victims are abducted or kidnapped, traffickers will use other recruiting methods such as debt bondage, coercion, fraud, and false promises to lure victims.

The PEARR (Privacy, Education, Ask, Respect & Respond) Tool is a suite of procedures to help social workers, nurses, and other professionals provide assistance in a trauma-informed manner.

Finally, the Shared Learnings Manual gives guidelines and instruction on creating a human trafficking response program in your facility.

“These guidelines include internal victim response procedures to encourage other health systems and hospitals to implement similar programs to protect and support trafficked persons identified in the healthcare setting,” says Gibbs.

People also can contact Petra Linden, Director of International Community Health & Human Trafficking, at for further education on HTR and trauma.

Gibbs says she hopes HTR programs become a standard offering at all healthcare facilities.

All of the tools and procedures Dignity has developed reflect principles of a victim/patient-centered and trauma-informed approach, says Gibbs. In other words, they were “designed with the point of view and experiences of victims/patients in mind.” All facilities should take this approach, she says, and take into account the ways trauma can affect patients and staff—their behaviors and responses.

This is an excerpt from a member-only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor Journal.